Community Involvement In Promoting Neonatal & Infant Nutrition In Tribal Vadodara Deepak Foundation Vadodara INDIA June 12-13, 2012 Project supported by World Bank under SAR DM initiative Knowledge sharing forum, Kathmandu 1
Barriers in Improving Infant Survival and Nutrition in Tribal Areas High level of maternal anemia Suboptimal infant and young child feeding and care practices Poor hygiene and sanitation & unavailability of clean drinking water Under reporting, poor identification and referral of low birth weight Lack of convergence of health and nutrition services at village level Lack of systems to promote community ownership Source: Mid term analysis of large scale PPP intervention study (2005) June 12-13, 2012 Knowledge sharing forum, Kathmandu 2
Objectives Broad Objective: Improve neonatal and infant nutrition practices through convergence of inter departmental government services and community participation Specific Objectives: Promote parental and community involvement in documenting birth date, time of initiation breast feeding and birth weight with the help of horoscope Conduct monthly health and nutrition days and distribute complementary food premix balbhog and micronutrient supplements to 6-24 months old Promote convergence of services through various government departments June 12-13, 2012 Knowledge sharing forum, Kathmandu 3
Project Site 300 randomly selected villages from 4 tribal blocks of Vadodara District, Gujarat (India) Gujarat State Vadodara District June 12-13, 2012 4 Knowledge sharing forum, Kathmandu
Study Design Target Group: Children below two years of age, pregnant and nursing mothers, community members Study Design: Pre and post intervention design Project Period: 18 months (January 2010 June 2011) June 12-13, 2012 Knowledge sharing forum, Kathmandu 5
The Innovation Use of horoscope as a cultural tool for sensitizing and eliciting community participation in recording vital statistics and improving nutritional status of under two children in tribal areas. Horoscope in lieu of recording vital information on : - Date of birth - Time of birth - Time of initiation of breast feeding - Birth Weight within 24 hours June 12-13, 2012 Knowledge sharing forum, Kathmandu 6
Strategy for implementation Birth celebration through community participation Integration of services and Water Testing Monitoring distribution of supplements Provision of horoscope to parents for recording key indicators Improved vital registration and IYCF practices Community sensitization through wall paintings Leveraging on existing large scale PPP project June 12-13, 2012 Knowledge sharing forum, Kathmandu 7
Project Monitoring and Evaluation M&E Framework Targets: Increase recording of Birth Weight from 53% to >80%, Increase timely identification and referral of low birth weight babies from <1% to> 40%, Improve early initiation of breastfeeding from 27% to 80%, Reduce proportion of underweight children (<24 months) from 47% to <30% M&E approach Program Monitoring Evaluation Indicators Input % ASHAs trained Process % birth celebrations conducted % children receiving health and nutrition services Output % newborns given horoscope % LBW identified Outcome Indicators of IYCF practices % Birth registered % LBW referral Impact % infants in normal category of Nutritional Status Data Sources NFHS (2005-6), DLHS-III, Baseline and Endline surveys, project MIS formats maintained by ASHAs, SMCS MIS formats June 12-13, 2012 Knowledge sharing forum, Kathmandu 8
Data Collection and Flow Nutrition Project Implementation Team Training and Monitoring Team Project Manager Data processing & consolidation Associate Project Coordinator MIS Team M & E Officers Trainers Facilitators Block level (100-150 villages) Block Coordinators Office Assistants Monitoring Lab. Technicians D&R Assistants Data Entry M& E Assistants Cluster level (15-20 villages) Campaigns data Form 1 ORWs Data verification Village level (1000 population) Newborn Information Form-2 ASHAs M&C tracking Register (SMCS) June 12-13, 2012 Knowledge sharing forum, Kathmandu 9
Data Processing Data presentation and Review 1.Project Director 2.Block level teams District level (1548 villages) Data Extraction for Monthly tracking of indicators of all Projects including Monitoring findings Block level (100-150 villages) Cluster level (15-20 villages) Data Reaches Head Office at District through Electronic Mail Data Entry in Softwares 1. SAFAL net (SMCS) 2. Horo Software (Horoscope data) 3. Excel Sheet (Campaigns Data 200 villages) Data verification and compilation during cluster level meetings Independent Monitoring by Facilitators in 20% villages/month Village level (1000 population) Data Collection June 12-13, 2012 Knowledge sharing forum, Kathmandu 10
Results June 12-13, 2012 Knowledge sharing forum, Kathmandu 11
Newborns given Horoscope N=4339/7386 (58.7%) Timely collection of vital information facilitated horoscope distribution June 12-13, 2012 Knowledge sharing forum, Kathmandu 12
Birth Weight recording Increased N=6760/7386 (91.5%) While many newborns were reportedly weighed, information was not made available for generating horoscope June 12-13, 2012 Knowledge sharing forum, Kathmandu 13
Coverage: Average number of beneficiaries attending campaigns per campaign N=3023 The project assisted in improving service utilization Source : Nutrition Project form 1 June 12-13, 2012 Knowledge sharing forum, Kathmandu 14
Convergence: Nutrition campaigns attended by AWW,ASHA and ANM together N=1929/3023 (63.8%) % Source : Nutrition Project form 1 The project assisted in improving convergence to a certain level June 12-13, 2012 Knowledge sharing forum, Kathmandu 15
VHSC involvement : Campaigns attended by VHSC members N=1612/3023 (53.3%) VHSC involvement was difficult to elicit without sustained inputs Source : Nutrition Project form 1 June 12-13, 2012 Knowledge sharing forum, Kathmandu 16
Service delivery: 6-23 month old receiving complementary food premix at AWCs N=48832/61651(79.2%) More children started receiving CF premix at centers Source : MPR Register June 12-13, 2012 Knowledge sharing forum, Kathmandu 17
Birth Registration N=6143/7386 (83.2%) Source : Safal data Birth registration improved, was related to institutional delivery June 12-13, 2012 Knowledge sharing forum, Kathmandu 18
Referral of Low Birth Weight babies N=442/785 (56.3%) Unavailability of newborn care services affected referral Source : Horoscope data June 12-13, 2012 Knowledge sharing forum, Kathmandu 19
IYCF practices and Nutritional Status Indicators Target Baseline Value (%) Endline Value (%) % children put to the breast within one hour of birth % infants 0 5 months of age fed exclusively with breast milk % children (6-23m) consuming iron fortified complementary food premix (balbhog) % infants (0-23m) in normal category of Nutritional status 80 68.8 67.5 80 42.7 68.8 80-51.7 80 57.6 54.2 June 12-13, 2012 Knowledge sharing forum, Kathmandu 20
Discussion A tangible product can anchor behavior change, convergence and community mobilization efforts Demand creation needs to have a supply back up including availability of skilled manpower Linkages to all public departments are vital for overall impact Demand for nutrition services picks up quickly, but behavior change lags behind Project period too short to show impact on nutritional status June 12-13, 2012 Knowledge sharing forum, Kathmandu 21
Challenges and Actions Manpower attrition Interdepartmental convergence Safe water and sanitation Erratic Supplies Technology glitches Optimization through time planning, local decision making Combined meetings, trainings, mutual coordination, data sharing Awareness generated but services limited Advocacy, demand generation, Public Hearings Time bound problem redressal June 12-13, 2012 Knowledge sharing forum, Kathmandu 22
Final Thoughts Sanitation and infection control measures should be integral to nutrition improvement programs Supplies of products which aid nutrition behaviors should be adequate to meet demand Capacity building and continued mentoring of frontline health and nutrition functionaries including ASHAs in nutrition and care of newborn Existing service delivery need to be realigned into community owned models addressing hunger and malnutrition especially in tribal areas June 12-13, 2012 Knowledge sharing forum, Kathmandu 23
Thank You June 12-13, 2012 Knowledge sharing forum, Kathmandu 24